Smallpox Vaccine: Screening and Contraindications Based on CDC Presentation December 2002

1
Smallpox VaccineScreening and
Contraindications Based on CDC
PresentationDecember 2002

• DHMH/Community Heath Administration
• Office of Public Health Preparedness and Response

2
Transmission of Vaccinia

• Vaccinia virus may be recovered from the site of
  vaccination from development of papule (2-5 days)
  until scab separates from the skin (2-3 weeks
  later)
• Household contacts at highest risk of contact
  transmission

3
Major Complications of Smallpox Vaccination

• Inadvertent autoinoculation Site care/hygiene
• Eczema vaccinatum H/O eczema
• Generalized vaccinia
• Progressive vaccinia H/O immune problem
• Postvaccinal encephalitis
• Fetal Vaccinia H/O pregnancy

4
Contraindications and Screening

• Learning Objectives
• Train vaccination clinic staff to screen
  potential vaccinees for contraindications of
  smallpox vaccine, including
• Contraindications in potential vaccinees AND
• Contraindications in household contacts

5
Smallpox Vaccine Facts

• Vaccine contains live vaccinia virus
• Vaccine virus can be transmitted to household and
  other close contacts
• Candidates for vaccination need to be carefully
  screened for contraindications
• Certain medical conditions in the persons
  household contacts must also be considered as
  contraindications for vaccination

6
Contraindications and Screening(Non-emergency
Situation)

• Serious Allergic Reaction to a prior dose of
  vaccine, or to a vaccine component

7
Smallpox Vaccine Components

• DryVax
• Polymyxin B
• Streptomycin
• Tetracycline
• Neomycin
• Phenol
• Other vaccine formulations do not contain
  antibiotics

8
Contraindications and Screening(Non-emergency
Situation)

• Serious Allergic Reaction to a prior dose of
  vaccine, or to a vaccine component
• Immunosuppression in the recipient or household
  contact

9
Causes of Immunosuppression1. Diseases

• Leukemia
• Lymphoma
• Generalized malignancy
• Solid organ or stem cell transplantation
• Humoral or cellular immunity disorders
• HIV infection

10
Causes of Immunosuppression2. Therapies

• Alkylating agents
• Antimetabolites
• Radiation
• High-dose corticosteroid therapy
• gt 2 mg/kg/day, OR
• gt 20 mg/day for gt 14 days

11
Screening for HIV Infection

• Mandatory HIV testing not recommended, but
• Recommended for persons who have history of risk
  factor(s) and do not know status
• Should be readily available for anyone concerned
  who wishes testing

12
Contraindications and Screening(Non-emergency
Situation)

• Serious Allergic Reaction to a prior dose of
  vaccine, or to a vaccine component
• Immunosuppression in the recipient or household
  contact
• Pregnancy or pregnant household contact

13
Screening for Pregnancy

• In pre-event setting, vaccine should NOT be given
  to
• Pregnant women
• Women trying to become pregnant
• Educate women of child-bearing age about fetal
  vaccinia
• Advise avoidance of pregnancy for 4 weeks
  following vaccination

14
Screening for Pregnancy

• If potential vaccinee is concerned about her
  risk, administer home test for pregnancy
• Establish pregnancy registry for women
  inadvertently vaccinated

15
Contraindications and Screening(Non-emergency
Situation)

• Serious Allergic Reaction to a prior dose of
  vaccine, or to a vaccine component
• Immunosuppression in the recipient or household
  contact
• Pregnancy or pregnant household contact
• Breastfeeding

16
Contraindications and Screening(Non-emergency
Situation)

• Eczema or atopic dermatitis (current or past
  history) in the potential vaccinee or household
  contact
• Acute, chronic, or exfoliative skin conditions
  (until improved or resolved)

17
Screening for Eczema/Atopic Dermatitis

• Questions and Information
• Have you or member of your household been
  diagnosed with eczema or atopic dermatitis?
• Eczema/atopic dermatitis usually is itchy, red,
  scaly rash that lasts more than two weeks and
  comes and goes
• If you or household member EVER had a rash like
  this, you should NOT receive smallpox vaccine

18
Screening for Eczema/Atopic Dermatitis

• Do NOT administer if history of eczema or atopic
  dermatitis
• Do NOT administer if household members have
  history of eczema or atopic dermatitis
• Other acute, chronic, exfoliative conditions
  wait until resolved or under good control

19
Contraindications and Screening(Non-emergency
Situation)

• Eczema or atopic dermatitis (current or past
  history) in the potential vaccinee or household
  contact
• Acute, chronic, or exfoliative skin conditions
  (until improved or resolved)
• Children lt 12 months of age

20
Contraindications and Screening(Non-emergency
Situation)

• Eczema or atopic dermatitis (current or past
  history) in the potential vaccinee or household
  contact
• Acute, chronic, or exfoliative skin conditions
  (until improved or resolved)
• Children lt 12 months of age
• Moderate or severe acute illness

21
Contraindications and Screening(Non-emergency
Situation)

• Serious Allergic Reaction to a prior dose of
  vaccine, or to a vaccine component
• Immunosuppression in the recipient or household
  contact
• Pregnancy or pregnant household contact
• Breastfeeding

22
Contraindications and Screening(Non-emergency
Situation)

• Eczema or atopic dermatitis (current or past
  history) in the potential vaccinee or household
  contact
• Acute, chronic, or exfoliative skin conditions
  (until improved or resolved)
• Children lt 12 months of age
• Moderate or severe acute illness

23
Pre-Clinic Screening Materials

• Participant Advice Letter
• Vaccine Information Sheet (VIS)
• Pre-Clinic Screening Checklist

• Fact Sheets on
• Vaccine
• Immune System Problems
• Skin Conditions
• Pregnancy

24
For More Information

• CDC Smallpox website
• www.cdc.gov/smallpox
• National Immunization Program website
• www.cdc.gov/nip